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HomeMy WebLinkAbout008-1016-60-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) SAN-2018-162 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Robert & Patricia Read TOWN OF EAU GALLE 008-1016-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 06.28.16.848 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head T DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Hole Spacin Header/Manifold Distribution x Hole Size x g Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed Trench Center Bed Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 2166 55TH AVE 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? ❑ Yes ❑ No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) N c County Sanitary Permit Application ST. CROIX COUNTY WISCONSIN GpV,~ ccord with Chapert 12 St. Croix County Sanitary Ordinance PLANNING & ZONING DEPARTMENT I information you provide may be used for secondary purposes ST. CROIX COUNTY GOVERNMENT CENTER [Privacy Law. S. 15.04(1)(m)] 1101 Carmichael Road r Hudson, WI 54016-7710 (715)386-4680 Fax (715)386-4686 Attach ompiete plans for the sy 4M on pt peF!nbt ess `than 8-112 x 11 inches in size. t County Sanitary ` rmit # ❑ Chl;t application 611. I. Application info." ase Print all information Location: / Property Owkrer J~ 1/4_ 1/4, Sec / T N, Property Owner's Mailing Address Lot Number Number -2111,1'- ~55rA J- ~ 3 7c7 7 City, State Zip Code Phone Numer Subdivision Name or CSM Number V_ 4 PcJ 1/9~ II Type of Building: (check one) " PA:- Erity ❑ Village Q(Tow of 1 or 2 Family Dwelling - No. of Bedrooms: ❑ Public/Commercial (describe use): '7 r-' ❑ State-owned Nearest Ro p 11. Type of Permit: (Check only one box on line A. Check box on line B if applicable) ~ , 'R ~ L ,.r-- A) Parcel T& Number(s) 1.❑ Repair Reconnection 3. Non-plumbing 4. [D Rejuvenation Sanitation B) Permit Number Date lssu d State Sanitary Permit was previously issued TJ Z~ ` 113 IV. Type of POWT System: (Check all that apply) ❑ Non-pressurized In-ground p Mound ? 24 in. suitable soil j:WeMound 5 24 in. suitable soilMound A+0 ❑ Sand Filter ❑ Constructed Wetland ❑ Peat Filter ❑ Drip Line ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Other ❑ At-grade ❑ Aerobic Treatment Unit ❑ Recirculating 4*- V. Dispersal/Treatment Area information: 1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area 4. Soil Application Rate 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed (Gals./day/sq.ft.) (Min./inch) Elevation - ~/SC Vl. Tank Information Capaicty in Gallons Total # of Manufacturer Prefab Site Con- Steel Fiber- Plastic New Existing Gallons Tanks Concrete strutted glass Tanks Tanks 13 El 13 VII. Responsibility Statement It, the undersigned, assume responsibility for repair/reconnenction/rejuvenation/installation of non-plumbing for the POWTS shown on the attached plans. A license is not required for terralift repair or the installation of non-plumbing sanitation system. Plumber's 7ef~- nt ) Plumber's Si ature ~Pci sta ps):_ MP/MPRS No. Business Phone Number Plumber's Address (Street, Citt~, State, Zip Code) / Vill. County Use Only 17 Oisapp Sanitary Permit Fee D e !s p n gent Si atu No sta ps) lssui Approved Owner ni verse 5 G,} Determination / IX. Conditions of Approval/Reasons for Disapproval: 0 L Irv, J) f~tj >s . Rev: 8/05 -4 f JJ s z is l7P,-~~ t X ~3t e n r r J' uk«•^ y, ~ ~'~F ~+rretj."wy,c•. ~'w+4-n4p +i+?r.1`."r..y.. ~ ~ ~ .k i • ss.2 .rf~.. L #e nab j~ ~A. • r _ d~ d ! lcopy x sv ft a r F I RR r, r i` R fr - ~f p . ~ j r. E .5 f ~ ~.-d 3t ~ - ,y. { tk ~Y r• ~ f t , +f +.~s 4 y wo, et' 4 r j€ ` y 1144 r rpj~t Septic inspection for the property of 2166 55th Avenue Baldwin, WI 54002 Checked the septic system on June 15th, 2018, all was in good working condition. Mound was dry. Septic tank cover was flush with the ground. Need an extension, a chain and a locking device installed. Pump tank needs a lock on a steel cover. Tank has been pumped and maintained. Baffles are intack. Thanks, Paul R Koehler Master Plumber 225410 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of '2- FILE INFORMATION SYSTEM SPECIFICATIONS Owner ROBERT READ Septic Tank Capacity 1200 gal ❑ NA Permit # 38456 Septic Tank Manufacturer WEEKS ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer EXNA Number of Bedrooms 3 ❑ NA Effluent Fitter Model CQ(NA Number of Public Facility Units QKNA Pump Tank Capacity 800 gal ❑ NA Estimated flow (average) 300 al/day Pump Tank Manufacturer WEEKS 11 NA Design flow (peak), (Estimated x 1.5) 450 al/day Pump Manufacturer HYDROMATIC 13 NA Soil Application Rate 4 al/day/ft' Pump Model SKD 50 ❑ NA Standard influent/Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD6) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD6) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <_10' cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA 'Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) CXyear(s) (Maximum 3 years) El NA Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 13 month(s) [Xyear(5) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) A ❑ year(s) Inspect pump, pump controls & alarm At least once every: 3 ❑ month(s) ❑ NA [Xyear(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) IMA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. i Page 2 of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T aluati a o ing~ank be' a ate nsn:' ~DIL1'1~ 4al S-Muc'l o ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name BENNIE HELGESON Name N/A Phone 715-778-4425 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name (bUti1 -2DAf lU Phone Phone (O 1D This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5401, (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Robert and Patricia Read Mailing Address 2166 55th ave Baldwin Wi Property Address same as above (Verification required from Planning & Zoning Department for new construction.) City/State Baldwin Wi Parcel Identification Number 008-1016-60-000 LEGAL DESCRIPTION A I Q Property Location SE '/4 N E '/a Sec. 6 , T 28 N R 1 6 W, Town of Eau Gall e Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house ❑yes[Dno Lot lines identifiable ❑yes❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on t is form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above y vi e of a w rranty deed recorded in Register of Deeds Office. N,~ m er f bedr s 3 e 6 /21 / 18 SIG A RE OF APPLICANT(S) DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) I The Lancaster Mod u OPT TRANSOMS ABOVE OPT TRANSOM ABOVE KM:NE , MA81ER i DINING 1S'd' I OR0011 1549 Sq Ft eE ooM ROOM 1 's~Aw a; A 14' -I E4- i G 1L _ Roo { t, : i I ss A O FEAT OEAING TNRII-OW N 3 Oo ~ I 6' H ~RJ~ I BEDROW 8 LNNG ROOM w tp- i W4* N&2 R0FM 6NDM61 Y i IIEL P~AT7~ W/COLUWS I ~ { GAO OPTION CORNER SHOWER BATH OPT TRANSOMS ABOVE OPT TRANSOM ABOVE OPT TRANSOM ABOVE Standard Features 2"x10" Door Joist 16" on Center Deep Stainless Steel Sink Double 2"x12" Rim Joists at Marriage Walls Single Level Faucet w/ Sprayer 3/4"OSB Tongue & Groove floor Decking White China Bath Sinks 2"x6" Wall Studs, 16" on Center, R-19 Insulation One-Piece Fiberglass Tubs and Showers 30 Year (livens Corning Architectural Shingles Delta Single Lever Anti-Scald Faucets in `Nubs & Shwr 8' Sidewalls and Flat Ceilings Throughout Premium Grade Vinyl Flooring Spatter Finish Drywall Throughout Ceramic Back Splash in Kitchen and Bathrooms R-40 Blown Roof Insulation Solid Oak Cabinets & Face Frames 401b 2"x4" Roof Trusses Choice of 42" or Staggered Kitchen Cabinets 5/12 Roof Pitch w/ 22" Overhangs 6 Panel Interior I oo s Horizontal Vinyl Lap Siding 200 Amp Service for Basement House Wind Wrap (2) Outside Fxterior Outlets Vinyl Windows w/ Insulated Low "E" Glass Whirlpoo130" Gas Range (2) Exterior Faucets 18 C.F. Whirlpool Refrigerator Suggested Options Additional Options Shown Rounded Drywall Corners Spacesaver Microwave Lighted Paddle Fan Clary Doors, Windows and Trim Can Lights in Kitchen Double Set. Back Dormer Utility Sink )dill Wall Ceramic in Kitchen Patio Door wBlinds & Wood Valance Glamour Bath w/ Drop in Tub & Columns Bullnose Ceramic Edge 42"Shaker Oak Cabinet Doors Built in Whirlpool Dishwasher Hardwood Moldings 30" Whirlpool Electric Range Paint By Others Town and Count Homing 4285 Y. Prairie View Rd, Chippewa Fa//f, W/ 54729 (715)834-a79 Visit us on the web at www.townandcountryhousing.com Specifications Subject to change without notice [APARTMENT OF INDUSTRY, INSPECTION REPORT FOR SAFETY & BUILDING: L4BOr. &1-IUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISIOIN P.O. BOX 7969 BUREAU OF PLUMBINC MADISON, WI 53707 C_1CONVENTIONAL ®ALTERNATIVE ware Pla ID Numbe. 11, ass~9~~edl Holding Tank E-1 In Pressure X1 Mound NAME OF PERMIT HOLDER _____::~DDRESS OF PERMIT HOLDER INSPECTION DATE Harvey Hielkema 990 Hillcrest St., Baldwin, WI 54 310 PE NCH MARK (Pei na~.~-~: ~rference P(-,T) DESCRIBE IF DIFFERENT FROM PL AN REF_ PT. ELEV CST REF P .ELEV SE NE, Sec. 6, T28N-R16W, Town of Eau Galle N"-, "t Piurr~he` MP,MPR SW N11- Cou~.Iy Sanitary P-o Number Bennie Helgeson 3215 St. Croix 38456 - ~ SEPTIC TANK/HOLDING TANK:_ VANUFACTURER LIQUID CAPACITY TANK INLET ELEV LANK QUTI EI ELEV WARMNG LA8EL LOCKING OOV R Pq OVI DED PROVID cYh/' J2oV ) DYES LINO ❑~E LJNO F EDOING VENT OIA VENT Alt HI(;H WATER NUMBER OF ROAD JLIN ROPERTY WELL BUILDING 1VENT TOFRESH od IALARM EILIA FEET F DYES ,Np YES L_~NO N EARESTOML~t'', ./i I---' DOSING CHAMBER: - - ~ _ I'^ INUfACTUREn BEDDING II)UID CAPACI TV PUMPMODEI Pu MP1 SIPHONMANUI ACf(IHEH WARNING LABEL LOCKING COVER / t J ir) PROVIDED PROV DIED j ( L L)YES NO G r C NYES LINO YES ❑NO GALLONS'ER CYCLE: PUMP AND CONTROLS OPERAT IONA L NUMBER OF PROPFRTY WELL BUILDINI VENT TO FRESH (DIFFERENCE BETWEEN EYES FEET FROM I INe J~ AIR IN,tf PUMP ON AND OFF) EYES L 'NO NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing I I TH I,IAMF Tf H MATE FRAIL AND MARKIN' or excavation.' Of soil can be rolled into a wire, construction shall cease until MAIRNE the soil is dry enough to continue.l 1 CONVENTIONAL SYSTEM: WIDTH LENGTH NO F irTTt- IPE SPAC IN(, COVER JINSIDE DIA -PITS LIQUID BED/TRENCH R MATERIAL PIT DEPTH DIMENSIONS ; I~ 1, IV 'VFL DEPTH FIL I_DEPTH IIISTH PIPE pISTR WE ISTH. PIPE MATERIAL NO DISTR NUMBER OF PROPERTY WELL BUILDING VENT TO FRES/ r k I r)W PIPES ABOVE (.OVER F I F V IN" T E I Q V tNU PIPES LINE AIR INLET FEET FROM ~ - - _ NEAREST-~ MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OFSYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. 1 IONS MEASURED. YES [ _]NO SOIL COVER FxTURE PFHMn^aENT MARKERS ORSFRVATION WELLS - DYES ES L. NO _ I'4TH OVER TRENCH BFD DEPTH OVER TkEN(t{9E LI I,f PTI1 Ir TOP,(iIL tittl)[1F SEE DE I) =10 D R DYES NO L.IYES CNO ES ❑NO 01 PRESSURIZED DISTRIBUTION SYSTEM: _ WIDTH i I EN(, fU NO OF I ATERAL SPACING (ERA- VEL DEPTH BELOW PIPri FILL DEPTH ABOVE COVER BED/TRENCH t TRENCHES / t / S DIMENSIONS S . O MANIFOLD PUMP MANIFOLD DISTR PIPE MANIFOLD MATERIAL NO DISTR DISTR PIPE DISTRIBUTION PIP MATERIAL 11 MARKING ELEVATION AND E EV EI V DIA EL V PIPES DIA r, / 2 '1j ul DISTRIBUTION INFORMATION HOLE SIZE HOLF SPACING DRIL I LD CORRECT L Y COVER MATERIAL VFRNTI CAI I II T CORR SPONS T© A O _ PI A li S R lO / `7 'YES ONO ❑YES NO COMMENTS: PERMANENT MARKERS OBSERVATION WELLS - NUMBER OF PROPERTY WELL BUILDING FEET FROM LING ,YES _1N0 YES NO NEAREST' fk 7< r4, L .J L Sketch Systern On - - l -Retain in county file for audit. le Side. f- ' _ :z ~'SLtill,• Gt SIGNATURE nTLE li l~. j s. SBD 6710 (R. 01/82) } ` y DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION AN P.O. BOX 76 HUMAN REDLATIONS PERCOLATION TESTS (115) MADISON W1 3707 !_lCrT10/ - SECTION: /R// ) W 7TIWNSH5IP/M4+'ttetr&n-;:~~: LOT NO.1BLK. NO.: SUBDIVISION NAME: COUNTY: OWN R'S/BUYER'S NA E: MAILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS. COMMER IAL DESCRIPTION. PROFILE OHS: ER OLA N TESTS: Residence _ L[ ❑New L_7fieplace RATING: S= Site suitable for system U= Site unsuitable for system - - - - - HOLD - - U D V TR~OMMENE 'ONL~SJ IL' f VL MO ND. ❑U ❑ OUN IN GR S QPR1hT E SYSTSS EM-IN-FI PS ~ SYSTEM:(optional) if Percolation Tests are NOT required DESIGN RATE: STEM ELEVa 1 1f If any portion of the lot is in the under s.H63.09(5)(b) indicate: Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED-_ EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) 9 S / ' s Qn S~,CLy SC F-F • G IB- Alto r~ !O",B1.f;` s i0'r S.t S, Cl /C~'t S'C l F.~A °'^sM m 13- _ L/° B- I B- PERCOLATION TESTS I TEST DEPTH WATER IN HOLE TEST TIME I DROP IN WATER LEVEL-INCHES RATE MINUI ES NUMBER INCHES AFTE~RLING_ INTR'VAL MIN. f RtoU _p R) j~ --_/~D PER !NG~ti j EOD2 P- P- PLAN VIEW: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and ,t,c direc!io^ Lind percent of land slop. SYSTEM EL VATION 9ccv./ih~ .~C,,: u Pei ' socc ~ F3 h "D !6 / r ~ Q1 RI 't